Stability of Treatment Gains 10 Years After Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: a Study in Routine Clinical Practice
- 9 Downloads
Abstract
Individual cognitive behavioral therapy (CBT) is the treatment of choice for OCD, as demonstrated by RCTs. Nonetheless, the stability of long-term treatment gains has been investigated less. This study aims to test the stability of CBT gains for OCD after 10 years when CBT is delivered in community settings in routine clinical practice. Fifty-one OCD patients started the treatment, and 43 completed it. Forty-one patients were available at 1-year follow-up, and 29 at 10-year follow-up. CBT was effective in decreasing OCD severity, depression, dysfunctional beliefs about obsessions, and thought-suppressing tendencies. These changes occurred at post-treatment and remained stable 1 year and 10 years later. The effect sizes of changes were large for Y-BOCS. In all, 58.62% of patients were recovered after CBT, and this was maintained 10 years later. The results show that CBT for OCD can be delivered in routine clinical practice without compromising efficacy.
Keywords
OCD Clinically significant changes CBT Follow-upNotes
Compliance with Ethical Standards
The Ethics Committees of the Hospitals approved the study design and the assessment and treatment protocols.
References
- Abramowitz, J. S., & Foa, E. (2000). Does comorbid major depressive disorder influence outcome of exposure and response prevention for OCD? Behav Ther, 31, 795–800.CrossRefGoogle Scholar
- Aderka, I. M., Anholt, G. E., van Balkom, A. J. L. M., Smit, J. H., Hermesh, H., Hofmann, S. G., et al. (2011). Differences between early and late drop-outs from treatment for obsessive-compulsive disorder. Journal of Anxiety Disorders, 25, 918–923.CrossRefPubMedGoogle Scholar
- American Psychiatric Association (2002). Diagnostic and statistical manual of mental disorders, 4th ed., text rev. Washington, DC: Author.Google Scholar
- Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.Google Scholar
- Becker, B. J. (1988). Synthesizing standardized mean-change measures. Br J Math Stat Psychol, 41, 257–278.CrossRefGoogle Scholar
- Belloch, A., Cabedo, E., Morillo, C., Lucero, M., & Carrió, C. (2003). Design of an instrument to assess dysfunctional beliefs in obsessive-compulsive disorder: preliminary results of the obsessional beliefs Spanish Inventory. Int J Clin Health Psychol, 3, 235–250.Google Scholar
- Belloch, A., Cabedo, E., & Carrió, C. (2008). Cognitive versus behavior therapy in the individual treatment of obsessive-compulsive disorder: changes in cognitions and clinically significant outcomes at post-treatment and one-year follow-up. Behavioral and Cognitive Psychotherapy, 36, 521–540.CrossRefGoogle Scholar
- Belloch, A., Cabedo, E., Carrió, C., & Larsson, C. (2010a). Cognitive therapy for autogenous and reactive obsessions: clinical and cognitive outcomes at post-treatment and 1-year follow-up. Journal of Anxiety Disorders, 24, 573–580.CrossRefPubMedGoogle Scholar
- Belloch, A., Morillo, C., Luciano, J. V., García-Soriano, G., Cabedo, E., & Carrió, C. (2010b). Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity. The Spanish Journal of Psychology, 13, 369–381.CrossRefGoogle Scholar
- Besiroglu, L., Uguz, F., Saglam, M., Agargun, M. Y., & Cilli, A. S. (2007). Factors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder. J Affect Disord, 102, 73–79.CrossRefPubMedGoogle Scholar
- Boschen, M. J., & Drummond, L. M. (2012). Community treatment of severe, refractory obsessive-compulsive disorder. Behav Res Ther, 50, 203–209.CrossRefPubMedGoogle Scholar
- Braga, D. T., Cordioli, A., Niederauer, K., & Manfro, G. G. (2005). Cognitive-behavioral group therapy for obsessive-compulsive disorder: a 1-year follow-up. Acta Psychiatr Scand, 112, 180–186.CrossRefPubMedGoogle Scholar
- Cabedo, E., Belloch, A., Larsson, C., Carrió, C., Fernández-Álvarez, H., & García, F. (2010). Group versus individual cognitive treatment for obsessive-compulsive disorder: changes in severity at post-treatment and one-year follow-up. Behav Cogn Psychother, 38, 227–232.CrossRefPubMedGoogle Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
- Cottraux, J., Note, I., Nan Yao, S., Lafont, S., Note, B., Mollard, E., Bouvard, M., Sauteraud, A., Bourgeoisand, M., & Dartigues, J. F. (2001). A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychother Psychosom, 70, 288–297.CrossRefPubMedGoogle Scholar
- Denys, D., Tenney, N., van Megen, H. J. G. M., de Geus, F., & Westenberg, H. G. M. (2004). Axis I and II comorbidity in a large sample of patients with obsessive–compulsive disorder. J Affect Disord, 80, 155–162.CrossRefPubMedGoogle Scholar
- Di Mauro, J., Domingues, J., Fernández, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult out patient sample: a follow-up study. Behav Res Ther, 51, 82–86.CrossRefGoogle Scholar
- Eddy, K. T., Dutra, L., Bradley, R., & Westen, D. (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clin Psychol Rev, 24, 1011–1030.CrossRefPubMedGoogle Scholar
- First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1999). Entrevista Clínica Estructurada para los Trastornos de Personalidad del Eje II del DSM-IV. Barcelona: Masson.Google Scholar
- Fisher, P. L., & Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive compulsive disorder? A clinical significant analysis. Behav Res Ther, 43, 1543–1558.CrossRefPubMedGoogle Scholar
- Franklin, M. E., Abramowitz, J. S., Kozak, M. J., Levitt, J. T., & Foa, E. B. (2000). Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: randomized compared with no randomized samples. J Consult Clin Psychol, 68, 594–602.CrossRefPubMedGoogle Scholar
- Freeston, M. H., Léger, E., & Ladouceur, R. (2001). Cognitive therapy of obsessive thoughts. Cogn Behav Pract, 8, 61–78.CrossRefGoogle Scholar
- Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleishman, R. J., Hill, C. L., et al. (1989a). The Yale-Brown Obsessive-Compulsive Scale (I): development, use and reliability. Arch Gen Psychiatry, 46, 1006–1011.CrossRefPubMedGoogle Scholar
- Goodman, W. K., Price, L. H., Ramussen, S. A., Mazure, C., Delgado, F., Heninger, G. R., et al. (1989b). The Yale-Brown Obsessive-Compulsive Scale (II): validity. Arch Gen Psychiatry, 46, 1012–1016.CrossRefPubMedGoogle Scholar
- Houghton, S., Saxon, D., Bradburn, M., Ricketts, T., & Hardy, G. (2010). The effectiveness of routinely delivered cognitive behavioural therapy for obsessive–compulsive disorder: a benchmarking study. Br J Clin Psychol, 49, 472–489.CrossRefGoogle Scholar
- Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol, 59, 12–19.CrossRefPubMedGoogle Scholar
- Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry, 62(6), 593–602.CrossRefPubMedGoogle Scholar
- Kyrios, M., Hordern, C., & Fassnacht, D. B. (2015). Predictors of response to cognitive-behavior therapy for obsessive-compulsive disorder. Int J Clin Health Psychol, 15, 181–190.CrossRefGoogle Scholar
- Markarian, Y., Larson, M. J., Aldea, M. A., Baldwin, S. A., Good, D., Berkeljon, A., Murphy, T. K., Storch, E. A., & McKay, D. (2010). Multiple pathways to functional impairment in obsessive–compulsive disorder. Clin Psychol Rev, 30, 78–88.CrossRefPubMedGoogle Scholar
- McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stain, D., Kyrios, M., Matthews, K., & Veale, D. (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res, 227, 104–113.CrossRefPubMedGoogle Scholar
- Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Lifetime version. New York: Graywind.Google Scholar
- Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther, 35, 667–681.CrossRefGoogle Scholar
- Obsessive Compulsive Cognitions Working Group. (2001). Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behav Res Ther, 39, 987–1006.CrossRefGoogle Scholar
- Olatunji, B. O., Rosenfield, D., Tart, C. D., Cottraux, J., Powers, M. B., & Smits, J. A. (2013). Behavioral versus cognitive treatment of obsessive–compulsive disorder: an examination of outcome and mediators of change. J Consult Clin Psychol, 81, 415–428.CrossRefPubMedGoogle Scholar
- Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive compulsive disorder. A systematic review and meta-analysis of studies published. Clinical Psychology Review, 40, 156–169.CrossRefPubMedGoogle Scholar
- Purdon, C., & Clark, D. A. (2005). Overcoming obsessive thoughts. Oakland, CA: New Harbinger.Google Scholar
- Rachman, S. J. (2003). The treatment of obsessions. Oxford: Oxford University Press.CrossRefGoogle Scholar
- Salkovskis, P. M. (1996). Cognitive-behavioral approaches to the understanding of obsessional problems. In R. Rapee (Ed.), Current controversies in the anxiety disorders (pp. 103–133). New York: Guilford.Google Scholar
- Salkovskis, P. M., & Warwick, H. C. (1988). Cognitive therapy of obsessive-compulsive disorder. In C. Perris, I. M. Blackburn, & H. Perris (Eds.), Cognitive psychotherapy: Theory and practice (pp. 376–395). Berlin: Springer Verlag.CrossRefGoogle Scholar
- Sookman, D., & Steketee, G. (2010). Specialized cognitive behavior therapy for treatment-resistant obsessive compulsive disorder. In D. Sookman & R. L. Leahy (Eds.), Treatment resistant anxiety disorders: resolving impasses to symptom remission (pp. 31–74). New York: Routledge.Google Scholar
- Steketee, G., Chambless, D. L., & Tran, G. Q. (2001). Effects of Axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia. Compr Psychiatry, 42, 76–86.CrossRefPubMedGoogle Scholar
- Thiel, N., Hertenstein, E., Nissen, C., Herbst, N., Külz, A. K., & Voderholzer, U. (2013). The effect of personality disorders on treatment outcomes in patients with obsessive-compulsive disorders. J Personal Disord, 27, 697–715.CrossRefGoogle Scholar
- Van Oppen, P., De Haan, E., van Balkom, A. J., Spinhoven, P., Hoogduin, K., & van Dick, R. (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behav Res Ther, 33, 379–390.CrossRefPubMedGoogle Scholar
- Van Oppen, P., Van Balkom, A. J., de Haan, E., & Emmelkamp, P. M. G. (2005). Cognitive therapy and exposure in vivo alone and in combination with fluvoxamine in obsessive–compulsive disorder: a 5-year follow-up. J Clin Psychiatry, 66, 1415–1422.CrossRefPubMedGoogle Scholar
- Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. J Pers, 62, 615–640.CrossRefGoogle Scholar
- Whittal, M. L., Thordarson, D. S., & McLean, P. D. (2005). Treatment of obsessive-compulsive disorder: cognitive behavior therapy versus exposure and response prevention. Behav Res Ther, 43, 1559–1576.CrossRefPubMedGoogle Scholar
- Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D. (2008). Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: a 2-year follow-up of two randomized trials. J Consult Clin Psychol, 76, 1003–1014.CrossRefPubMedGoogle Scholar